Five U.S. airports begin screening for Ebola among travelers from West Africa

Gov. Rick Perry today announced the creation of a state-of-the-art Ebola treatment and infectious disease bio containment facility in North Texas. Creation of such facilities was among the first recommendations made by the governor’s recently named Texas Task Force on Infectious Disease Preparedness and Response in order to better protect health care workers and the public from the spread of pandemic diseases.

PROOF: Feds Knew Ebola Would Hit U.S. in September

By Aaron Blake

Nearly two-thirds of Americans say they are concerned about an Ebola outbreak in the United States, and about the same amount say they want flight restrictions from the countries in West Africa where the disease has quickly spread.

A new poll from the Washington Post and ABC News shows 67 percent of people say they would support restricting entry to the United States from countries struggling with Ebola. Another 91 percent would like to see stricter screening procedures at U.S. airports in response to the disease’s spread.

Thus far, some countries in Europe have restricted flights from these countries in West Africa, and an increasing number of U.S. lawmakers are calling for similar bans. The White House has yet to increase restrictions, with federal officials saying such a move could actually increase the spread of the disease by hampering the movement of aid workers and supplies.
Concern about Ebola, at this point, is real but not pervasive. About two-thirds (65 percent) say they are concerned about an Ebola outbreak in the United States. But while people are broadly concerned about an outbreak, they are not necessarily worried about that potential outbreak directly affecting them. Just 43 percent of people are worried about themselves or someone in their family becoming infected – including 20 percent who are “very worried.”

That finding echoes a Pew poll from last week which showed just 11 percent were “very worried” about themselves or their families becoming infected. Since that survey, Dallas Ebola patient Thomas Eric Duncan died, and news that a nurse who provided care for him became infected broke on the final day of the Post-ABC poll.

By comparison, slightly more Americans said they were worried about the H1N1 virus – a.k.a. the swine flu – in October 2009 (52 percent). Concern about Ebola is about on-par with concern about Avian influenza – a.k.a. the bird flu – in 2006 (41 percent) and slightly higher than concern about Sudden Acute Respiratory Syndrome (SARS) in 2003 (as high as 38 percent).
The support for increasing restrictions puts the White House in a tough spot. Given the moves by other countries and the American public’s stance, there is increasing pressure to act. And given the very real — but still somewhat muted — concerns about the disease, that’s significant, especially if the disease continues to expand.

West Africa travelers must go to 1 of 5 airports

The Department of Homeland Security announced Tuesday that all travelers from Ebola outbreak countries in West Africa will be funneled through one of five U.S. airports with enhanced screening starting Wednesday.

Customs and Border Protection within the department began enhanced screening — checking the traveler’s temperature and asking about possible exposure to Ebola — at New York’s John F. Kennedy International Airport on Oct. 11.

All travelers from Liberia, Sierra Leone and Guinea in West Africa will be funneled through one of five U.S. airports with enhanced screening.(Photo: Janet Loehrke, USA TODAY)

Those airports were supposed to screen 94% of the average 150 people per day arriving from the three countries. Lawmakers from other states asked for enhanced screening at their airports, too.

Some lawmakers have called for more restrictions, such as suspending visas or denying entry at ports for citizens from the three countries.

Jeh Johnson, secretary of Homeland Security, announced that travelers from West Africa must arrive at one of the five airports starting Wednesday.

“We are working closely with the airlines to implement these restrictions with minimal travel disruption,” Johnson said. “If not already handled by the airlines, the few impacted travelers should contact the airlines for rebooking as needed.”

The enhanced screening will apply to anyone who traveled recently to, from or through the three outbreak countries, according to the department’s announcement to be published Thursday in the Federal Register. Customs and Border Protection will work with airlines to identify potential travelers before they board, but airlines will be obligated to comply with the rule for carrying to the USA any passengers who recently traveled through the region, according to the filing.

The restrictions should affect only about nine travelers per day who would have arrived at other airports. Katie Cody, a spokeswoman for American Airlines, which serves Europe from hubs such as Philadelphia and Charlotte, said the airline has no concerns about the change.

“We have been tracking that, and we don’t have any concerns because the numbers are so small,” Cody said.

British Airways, which serves a variety of U.S. destinations other than the five targeted airports, said it would comply with the measures.

“Customers affected will be offered a refund or will be rerouted if there is availability,” spokeswoman Michele Kropf said.

“In addition to requiring all travelers from at-risk countries to fly through airports with enhanced screening measures in place, I continue to call on the administration to suspend all visas from Liberia, Sierra Leone and Guinea,” said Rep. Michael McCaul, R-Texas, the head of the House Homeland Security Committee.

The head of the House Judiciary Committee, Rep. Bob Goodlatte, R-Va., said a “real solution” is to deny entry to anyone from the three countries under a provision of the 1952 Immigration and Nationality Act.

“President Obama has a real solution at his disposal under current law and can use it at any time to temporarily ban foreign nationals from entering the United States from Ebola-ravaged countries,” Goodlatte said. “The vast majority of Americans strongly support such a travel moratorium, and I urge the president to take every step possible to protect the American people from danger.”

Rep. John Conyers of Michigan, the top Democrat on the House Judiciary Committee, said steering travelers through the five airports is a sensible precaution.

“As agreed upon by experts in both the public health and transportation communities, issuing a blanket travel ban would not only be counterproductive, but it would also irresponsibly impede getting much-needed supplies and relief to the countries that need it most,” Conyers said.

Roger Dow, CEO of the U.S. Travel Association, a trade group for all aspects of travel, praised the move to calm travel concerns while avoiding a travel ban.

“The Obama administration continues to heed the counsel of an overwhelming consensus of health and security experts and resist calls for any sort of travel ban on the grounds that it will be counterproductive to efforts to contain Ebola,” Dow said.

A Liberian national, Thomas Eric Duncan, who became the first person diagnosed with the disease in the USA after arriving in Dallas on Sept. 20, had a temperature of 97.3 degrees but didn’t tell airport officials in Monrovia, Liberia, that he had cared for a pregnant woman suffering from Ebola. He died Oct. 8, and two nurses who treated him have become infected.

Sen. Charles Schumer, D-N.Y., said the enhanced screening adds a layer of protection against Ebola entering the country.

“The Department of Homeland Security’s policy to funnel all passengers arriving from Ebola hot spots to one of these five equipped airports is a good and effective step towards tightening the net and further protecting our citizens,” Schumer said.

Obama and Johnson have said they will continue to monitor travel restrictions for possible changes.

“We are continually evaluating whether additional restrictions or added screening and precautionary measures are necessary to protect the American people and will act accordingly,” Johnson said.

Gabbard Calls On CDC To Increase Incubation Period To Prevent Ebola Spread

By Chad Blair

Rep. Tulsi Gabbard (D-HI) has called on the Center for Disease Control to implement stricter incubation guidelines for people who have been in contact with patients “confirmed or suspected” to have the Ebola virus.

According to a press release from her office, Gabbard is calling on the CDC to increase the quarantine and restriction period from the 21-day standard to 42 days, “based on the latest scientific studies and the World Health Organization report that the incubation period for the deadly Ebola virus can extend as long as 42 days.”

On Friday, Gabbard called for the “immediate suspension” of visas for citizens of Ebola-stricken West African nations as well as flights from those countries into the United States.

“Recent mistakes have revealed that the U.S. public health system is clearly not fully prepared to combat Ebola and prevent its spread in the United States,” she said in a statement.

Democrats like Gabbard are among a growing number who are “beginning to sound more like Republicans when they talk about Ebola. And Republicans are moving into overdrive with their criticism of the government’s handling of the deadly virus,” according to The Washington Post.

“The sharpened rhetoric, strategists say, suggests Democrats fear President Obama’s response to Ebola in the United States could become a political liability in the midterm election and Republicans see an opportunity to tie increasing concerns about the disease to the public’s broader worries about Obama’s leadership.”

The Washington Post notes, however, that Gabbard is “a liberal Democrat who is not in any danger of losing reelection.” It also reports that a Washington Post-ABC News poll showed that “67 percent of Americans would support restricting entry to the United States from countries fighting dealing with an Ebola crisis.”

How is the end of an Ebola outbreak decided and declared?

Information note – October 2014

Who decides the date?

The WHO Ebola outbreak response team is responsible for establishing the date of the end of the outbreak in collaboration with the affected country’s subcommittee for surveillance, epidemiology and laboratory.

How is the date determined?

An Ebola virus disease outbreak in a country can be declared over once 42 days have passed and no new cases have been detected. The 42 days represents twice the maximum incubation period for Ebola (21 days). This 42-day period starts from the last day that any person in the country had contact with a confirmed or probable Ebola case.

This includes health care workers who have been exposed to patients with Ebola virus disease, even if the health worker was wearing personal protective equipment and followed infection control procedures since such a person could be exposed accidentally without realizing it. In the setting of an Ebola treatment centre, the date of the last infectious contact is defined as the day when the last patient in the treatment centre tested negative for Ebola virus disease, using a real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test.

If no new case has been detected at the end of this 42-day period, the risk of a further case is very low, and the outbreak is declared over.

Why 42 days?

The maximum incubation period for Ebola virus disease is 21 days. The 42-day period set by WHO (twice the maximum incubation period) provides a margin of security to cover any possible missed cases, uncertainty in reporting dates or hidden chains of transmission. (*)

During the 42-day period, the surveillance system should be fully functional, so that all contacts of the last patient are followed to detect possible chains of transmission.

What is the procedure to make the declaration?

The WHO Ebola outbreak response team in collaboration with the affected country’s subcommittee for surveillance, epidemiology and laboratory determines the date of the end of the epidemic. The government of the affected country, in collaboration with WHO and international partners, makes an official declaration of the end of the epidemic.

Reversal: Obama sets Ebola travel restrictions

The Obama administration has reversed course on putting travel restrictions on those coming from three West African nations tainted with Ebola and is putting in place demands that they enter only through five U.S. airports prepared to screen for the virus.

Homeland Security Secretary Jeh Johnson said in a statement that the new rules will take effect Wednesday, bowing to demands from both parties that the U.S. do a better job so secure the border from Ebola.

“Today, as part of the Department of Homeland Security’s ongoing response to prevent the spread of Ebola to the United States, we are announcing travel restrictions in the form of additional screening and protective measures at our ports of entry for travelers from the three West African Ebola-affected countries,” said Johnson.

He said the rules require that anyone coming from Liberia, Sierra Leone or Guinea enter the U.S. only through the five airports where special Ebola screenings have been set up: New York’s John F. Kennedy, Newark Liberty, Washington Dulles, Atlanta’s Hartsfield-Jackson and Chicago’s O’Hare.

“All passengers arriving in the United States whose travel originates in Liberia, Sierra Leone or Guinea will be required to fly into one of the five airports that have the enhanced screening and additional resources in place. We are working closely with the airlines to implement these restrictions with minimal travel disruption. If not already handled by the airlines, the few impacted travelers should contact the airlines for rebooking, as needed,” said the statement.

He said that passengers flying into those airports on flights originating in Liberia, Sierra Leone and Guinea “are subject to secondary screening and added protocols, including having their temperature taken, before they can be admitted into the United States. These airports account for about 94 percent of travelers flying to the United States from these countries.”

There are no direct, non-stop commercial flights from Liberia, Sierra Leone or Guinea to the U.S.

Gov. Rick Perry today announced the creation of a state-of-the-art Ebola treatment and infectious disease bio containment facility in North Texas. Creation of such facilities was among the first recommendations made by the governor’s recently named Texas Task Force on Infectious Disease Preparedness and Response in order to better protect health care workers and the public from the spread of pandemic diseases.

In addition to the North Texas facility, The University of Texas Medical Branch at Galveston has also been designated an Ebola treatment and infectious disease bio containment facility.

“In the event of another diagnosis this facility will allow us to act quickly to limit the virus’ reach and give patients the care they need in an environment where health care workers are specially trained and equipped to deal with the unique requirements of this disease,” said Gov. Perry. “We are fortunate to have such talented and dedicated leaders here in North Texas, and at UTMB Galveston, who are willing to step forward during a time of need.”

Three of the region’s leading health care providers, UT Southwestern Medical Center, Methodist Health System and Parkland Hospital System, will partner to set up and operate the North Texas facility. The facility and equipment are being provided by partner hospitals, and staffing will be moved to the facility on an as-needed basis if the unit is activated.

UT Southwestern Medical Center is contributing the expertise of physicians experienced in infectious disease, critical care and other specialties, and some nursing professionals as staffing requires.

Methodist Health System is allowing the use of an entire floor of the Methodist Campus for Continuing Care in Richardson, including an ICU wing well suited for the care of infectious disease patients. They will provide some modifications for the critical steps of decontamination, laboratory equipment and other dedicated personnel for IT and biomedical support. Ebola and/or other infectious disease patients can be safely isolated

“UT Southwestern is proud that its expert faculty physicians and nurses are ready to lead in providing the very best care possible while safeguarding the safety of staff and the public. UTSW is also committed to advancing the other important longer term goals identified by the Governor’s Task Force,” said Dr. Daniel K. Podolsky, President, UT Southwestern Medical Center Building on the foundations that have made it an academic medical center that is respected worldwide, UTSW is committed to the education and training of caregivers broadly and to promote research which will improve disease treatment and prevention. There is no mission greater than serving the public good.”

“Methodist Health System answered the call because it is the right thing to do,” said Stephen L. Mansfield, PhD, FACHE, president and CEO, Methodist Health System. “Like all North Texans, we wish we weren’t in this situation. But the reality is there remains a threat, and as long as it’s there, Methodist is obligated by our mission — to improve and save lives through compassionate, quality health care — to do all we can to help.”

“Parkland is proud to be a part of this team effort to protect Texans from infectious disease. Our health system has a long history of emergency preparedness and clinical innovation so we are a great fit for this strike force,” said Frederick P. Cerise, MD, MPH, president and CEO, Parkland Health System. “Every Parkland employee comes to work knowing we may face the most difficult of situations and I am confident that we possess the skills and expertise to deal with them. Parkland also appreciates the leadership of Governor Perry as well as state and local officials in putting this team together.”

“UTMB is prepared to help fight Ebola and other infectious diseases,” said Dr. David L. Callender, UTMB president. “I have every confidence in our abilities to provide the highest level of care and we are proud that the governor has placed this trust in us as well as UT Southwestern, Methodist and Parkland.”

NIH unit treating Dallas nurse for Ebola is one of 4 special isolation facilities in U.S.

By Lena H. Sun

It has a specially designed air-flow system to prevent contaminated air from leaving the patient room. It requires anyone who enters to be buzzed in. Personnel who work there receive special training in infection control to prevent the spread of bio­terror agents, natural or man-made. It also has a tiny gym.

Welcome to the Special Clinical Studies Unit at the National Institutes of Health in Bethesda, Md. It is a 4,000-square-foot unit inside the NIH Clinical Center, the nation’s only hospital dedicated to research, which provides free state-of-the-art care to very sick patients from all over the world.

Now it’s home to its first confirmed Ebola patient, Nina Pham.
Pham is the first patient with a confirmed infectious disease to be cared for in the special seven-bed unit, center director John Gallin said in an interview Friday. Opened in 2010 for patients who need advanced isolation and extended stays, the unit was initially designed to take care of personnel working at the U.S. Army Medical Research Institute of Infectious Diseases in case they were exposed to infectious agents. In more recent years, it has been used to house healthy volunteers participating in live vaccine trials. The volunteers need to be monitored in a place where they can be safely quarantined, Gallin said. To accommodate those healthy volunteers, the unit has a dining room and a “tiny fitness area,” he said.

Pham, the first nurse diagnosed with Ebola after caring for a patient in Dallas, is in fair and stable condition, officials said Friday morning.
What does an Ebola isolation ward look like?
“We are giving her the best possible care on a symptomatic and systemic basis,” Anthony Fauci, director of NIH’s National Institute of Allergy and Infectious Diseases, said during a news conference.

Pham, 26, was transferred to the facility, one of four in the country with a special bio­containment unit, late Thursday. She was diagnosed with Ebola on Sunday, becoming the first person to contract the disease on U.S. soil. Pham had been part of the team that treated Thomas Eric Duncan, a Liberian man who flew to Dallas last month before being diagnosed with Ebola. Duncan died last week, four days before it was announced that Pham had contracted the disease.

“There is no specific therapy that has been proven to be effective against Ebola, and that’s why excellent medical care is critical,” Fauci said. He said Pham was “very, very tired” from her trip.

Patients infected with the Ebola virus require a large number of staffers to provide care around-the-clock. At NIH, that comes out to about 27 people a week — doctors, nurses, support staff — for one patient, Gallin said. With about 50 to 60 such personnel specially trained for infectious disease and critical care, NIH can only care for two Ebola patients at a time, he said.

The four facilities that provide such care were designed in the aftermath of the Sept. 11, 2001, terrorist attacks to protect against bio­terrorism. Two of them, Emory University Hospital in Atlanta and the Nebraska Medical Center, are each treating one Ebola patient. The other facility is St. Patrick Hospital in Missoula, Mont.

They require staff to undergo more rigorous training in infection control, and staff must follow strict protocol for putting on and taking off personal protective equipment in a separate anteroom. Officials say meticulous attention to detail in following protocols is what sets them apart from other facilities.
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Emory has treated three Ebola patients, all of whom have recovered. The University of Nebraska treated one patient who recovered and is now caring for a freelance NBC cameraman. St. Patrick has not yet treated an Ebola patient. The hospital has received so many inquiries that it has set up a special hotline where they are transcribed and forwarded to the appropriate departments.
Bruce Ribner gives a tour of the Emory University Hospital isolation unit which has been used for treatment of patients infected with the Ebola virus. (Emory University via YouTube)
Unlike the Dallas hospital where Pham and another nurse were infected, which officials said most likely occurred because of a breach of protocol involving personal protective equipment, no health workers taking care of the Ebola patients at the special facilities have become infected.

“There is a step-by-step, checklisted procedure to putting on your personal protective equipment for when you go in to the patient’s room to perform your duties and when you come out,” said Mark Rupp, medical director of Nebraska Medical Center’s infection control department, which includes the special unit. “That’s the big difference with what goes on in our unit and what goes on in a regular intensive-care unit.”

The facilities have one person whose only job is to make sure health-care workers put on and take off their protective equipment correctly. At NIH, this person is dubbed “the Watson,” Gallin said, for the sidekick to Sherlock Holmes.

The Watson “has the authority to stop everything at any moment if someone looks like they’re breaking protocol,” Gallin said. The Watson has a checklist, like a pilot’s preflight checklist, and everything has to be done in that order. If not, the Watson can “scream at them and tell them to stop,” Gallin said, which apparently happened at least once Thursday night when doctors and staff were admitting Pham.

The protective gear that health-care workers take off is autoclaved (sanitized via pressurized steam) and then incinerated. Equipment that is not disposable is disinfected according to the manufacturer’s directions. The units also have negative air pressure to prevent germs from spreading beyond patient rooms. For Ebola patients, contaminated air is not such a concern because the disease is not transmitted through the air, but through contact with bodily fluids.

The seven-bed, 4,000-square-foot biocontainment unit at the National Institutes of Health Clinical Center in Bethesda, Md., is a state-of-the-art facility built to keep the world’s scariest pathogens from escaping. The four U.S. facilities are all different — NIH’s even has a gym — but they contain many of the same things. This layout is based on the unit at Emory University in Atlanta.

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Fast Facts on US Hospitals

The American Hospital Association conducts an annual survey of hospitals in the United States. The data below, from the 2012 AHA Annual Survey, are a sample of what you will find in AHA Hospital Statistics, 2014 edition. The definitive source for aggregate hospital data and trend analysis, AHA Hospital Statistics includes current and historical data on utilization, personnel, revenue, expenses, managed care contracts, community health indicators, physician models, and much more.

AHA Hospital Statistics is published annually by Health Forum, an affiliate of the American Hospital Association. Additional details on AHA Hospital Statistics and other Health Forum data products are available at www.ahadataviewer.com. To order AHA Hospital Statistics, call (800) AHA-2626 or click on www.ahaonlinestore.com.

For further information or customized data and research, contact the AHA Resource Center at (312) 422-2050 or rc@aha.org.

*Registered hospitals are those hospitals that meet AHA’s criteria for registration as a hospital facility. Registered hospitals include AHA member hospitals as well as nonmember hospitals. For a complete listing of the criteria used for registration, please see Registration Requirements for Hospitals.

**Community hospitals are defined as all nonfederal, short-term general, and other special hospitals. Other special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; rehabilitation; orthopedic; and other individually described specialty services. Community hospitals include academic medical centers or other teaching hospitals if they are nonfederal short-term hospitals. Excluded are hospitals not accessible by the general public, such as prison hospitals or college infirmaries.

***System is defined by AHA as either a multihospital or a diversified single hospital system. A multihospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital preacute or postacute health care organizations. System affiliation does not preclude network participation.

**** Network is a group of hospitals, physicians, other providers, insurers and/or community agencies that work together to coordinate and deliver a broad spectrum of services to their community. Network participation does not preclude system affiliation.

Inside The Isolation Wards That Keep Americans Safe From Ebola

Ebola has officially made it to the US, but there is absolutely no reason to freak out. That’s in large part thanks to Emory University Hospital’s state-of-the-art isolation ward, which is better-equipped to field Ebola cases than any ordinary hospital in the country. Here’s a look at the tech that keeps doctors and nurses safe.

Emory is one of four high-level biocontainment patient care units in the US; the others are located at the National Institutes of Health in Maryland, Rocky Mountain Laboratories in Montana, and the University of Nebraska Medical Center. We spoke with Dr. Angela Hewlett, associate medical director at the Nebraska Biocontainment Patient Care Unit — the largest of the four facilities — about biocontainment suits, wearing three pairs of gloves, and custom air pressure systems.

Perhaps the most comfort Hewlett was able to provide is that none of the super-fancy tech that these four high-level isolation wards have at their disposal is even necessary for Ebola. “There’s a big fear factor with this illness but really, these types of patients can taken care of at any good healthcare facility,” says Dr. Hewlett.

That’s because the Ebola virus easily dies outside of the human body, so unless you’ve been handling a sick person’s blood or feces, you are almost certainly A-OK. Ebola is pretty darn hard to get compared to an airborne disease like SARS or even the regular old flu. But with a mortality rate of up to 90 per cent — and over 50 per cent with the strain in the current outbreak — we still need to keep doctors and nurses as safe as we can. Here’s how Nebraska Biocontainment Unit keeps diseases like Ebola — and much, much worse — from spreading in the hospital.

Negative air pressure. As with Emory in Atlanta, the isolation unit in Nebraska is isolated from the rest of the general hospital. It runs on its own air circulation system, and the air is passed through a high-efficiency particulate air (HEPA) filter before it is vented outside of the building. That’s the same kind of precautions that you would see in a biosafety level 4 lab (the highest) that works with deadly or highly contagious diseases.

In addition, the biocontainment unit has negative air pressure, which means that air pressure inside the isolation rooms is slightly lower than that outside. Essentially, air is gently sucked into the room, so particles from inside the room can’t float out when you open a door. As another line of protection, ultraviolet lights zap any viruses or bacteria in the air or on surfaces.

Full-body suits and THREE pairs of gloves. The Biocontainment Unit is equipped with gear that covers you head to toe, in some places three times over. That includes personal respirators, headgear, full-body suits and gloves. Healthcare workers wear three pairs, including one thick pair that protects against needle accidents, and then two pairs of ordinary gloves so they have an extra pair to work with patients.

Entering and exiting the room becomes an elaborate production because putting on and taking off all the gear can take more than 10 minutes each way. A second person assists to make sure every piece of equipment is put on right and there are no rips or tears in any of the protective gear. Afterwards, every piece of equipment is wiped down to kill the pathogen; in the case of Ebola, simple bleach is enough to do the trick. The full-body suit is discarded after each use.

Training and training and training. Having fancy technology is great but not if you don’t know how to use it properly. “They have to go through really extensive training,” says Hewlett of the the 30-person team that works in the unit. They get 80 hours of training before they can begin, followed by monthly meetings and quarterly drills, where the photos in this post were taken.

It’s worth reiterating that most of this equipment and these procedures go above and beyond protecting for Ebola. The air systems and full-body suits are really there to guard against possible airborne diseases, like smallpox or SARS or some highly contagious avian flu viruses that may emerge in the future.

In fact, the CDC’s current guidelines for treating Ebola in U.S. hospitals require only gloves, goggles, a facemask, and a gown in most situations. Even if someone inadvertently brings Ebola to other hospitals, it’s highly unlikely to spread in the U.S. The situation is different in Africa, where inadequate equipment and fear of healthcare workers has contributed to the worsening situation.

A State Department official did visit Nebraska to see whether the unit would be ready to accept any Ebola patients in the future, though the facility hasn’t yet been used despite being open for nine years. There hasn’t been a disease serious enough to merit it. “This is good thing,” says Dr. Hewlett, “However with world travel the way it is, it is inevitable these things are going to come eventually.” If and when Ebola does come to the U.S. again, we are definitely prepared, which is not something we can say about what else may be coming down the line.

Pictures: University of Nebraska Medical Center

Obama names Ron Klain as Ebola ‘czar’

David Jackson

President Obama tapped veteran government insider Ron Klain to coordinate his administration’s efforts to contain the Ebola virus Friday.

Klain, a former chief of staff to Vice Presidents Joe Biden and Al Gore, is well-known by Obama and White House aides. He was selected for his management experience and contacts throughout the government, White House spokesman Josh Earnest said.

“He is the right person for the job,” Earnest said, particularly the challenge of “integrating the interagency response.”

Klain’s appointment marks a swift turnabout for Obama, who until Thursday had resisted calls to appoint a single official to run the government’s response to Ebola.

Asked Thursday about the prospect of an “Ebola czar,” Obama said, “It may make sense for us to have one person, in part just so that after this initial surge of activity, we can have a more regular process just to make sure that we’re crossing all the t’s and dotting all the i’s going forward.”

USA TODAY

From recounts to stimulus to Ebola: Ron Klain’s resume

Obama did not mention Klain’s appointment during a speech Friday to the Consumer Financial Protection Bureau, but he said his administration is taking an “all-hands-on-deck” approach to fighting Ebola.

The administration has come under increased pressure to name an anti-Ebola coordinator in the wake of news that two nurses in Dallas contracted the deadly virus. Both had treated a man who died of Ebola.

Klain played a high-profile file in Gore’s 2000 presidential campaign. Oscar-winning actor Kevin Spacey portrayed him in an HBO movie on that year’s Florida recount.

The Ebola response includes efforts to screen travelers from West African nations where Ebola has reached epidemic proportions and killed more than 4,500 people. Klain will help coordinate the assistance the U.S. military provides in West Africa.

Some Republican lawmakers criticized Obama for entrusting the job to a former government manager rather than a professional.

Rep. Andy Harris, R-Md., tweeted, “Worst ebola epidemic in world history and Pres. Obama puts a government bureaucrat with no healthcare experience in charge. Is he serious?”

Members of the public health community expressed surprise.

“When are they going to stop making mistakes?” said Robert Murphy, the director of the Center for Global Health at Northwestern University’s Feinberg School of Medicine. “We need a czar, but optimally a strong public health expert. I am so disappointed. This is not what we need.”

Physician Amesh Adalja, a spokesman for the Infectious Diseases Society of America, said, “It’s clear that there’s a desperate desire for an organized approach to dealing with this outbreak. I don’t necessarily think we need a disease-specific czar — we have one for HIV — but more of an emerging infectious diseases/biosecurity coordinator who reports to the president.”

The Ebola position is designed to be more managerial in nature, involving an array of government agencies ranging from the Pentagon to Health and Human Services.

“This is much broader than a medical response,” Earnest said.

As for Republican criticism, Earnest joked, “That’s a shocking development.” He noted that national elections are less than three weeks away.

Klain may weigh in on another question facing the administration: the prospect of a U.S. travel ban from West African nations where there have been Ebola outbreaks.

Obama and aides have disputed the need for a travel ban, questioning whether it would work and arguing that it might create unintended problems.

Thursday, Obama said experts in infectious diseases have told him “a travel ban is less effective than the measures that we are currently instituting that involve screening passengers who are coming from West Africa.”

Klain is likely to take a low key role publicly.

Earnest said Obama wasn’t looking for an Ebola expert but “an implementation expert.”

He confirmed Klain’s title: “Ebola response coordinator.”

Klain will report to two officials involved in the anti-Ebola effort: homeland security adviser Lisa Monaco and national security adviser Susan Rice.

Obama is pleased with the work of Monaco and Rice, but “given their management of other national and homeland security priorities, additional bandwidth will further enhance the government’s Ebola response,” a White House official said, speaking on condition of anonymity.

The president has long known Klain, who helped prepare him for debates with Mitt Romney during the 2012 presidential campaign.

Klain has been out of government since leaving Biden’s staff during Obama’s first term.

Who Do They Think We Are?

By PEGGY NOONAN

The administration’s Ebola evasions reveal its disdain for the American people.

The administration’s handling of the Ebola crisis continues to be marked by double talk, runaround and gobbledygook. And its logic is worse than its language. In many of its actions, especially its public pronouncements, the government is functioning not as a soother of public anxiety but the cause of it.

An example this week came in the dialogue between Megyn Kelly of Fox News andThomas Frieden, director of the Centers for Disease Control.

Their conversation focused largely on the government’s refusal to stop travel into the United States by citizens of plague nations. “Why not put a travel ban in place,” Ms. Kelly asked, while we shore up the U.S. public-health system?

Dr. Frieden replied that we now have screening at airports, and “we’ve already recommended that all nonessential travel to these countries be stopped for Americans.” He added: “We’re always looking at ways that we can better protect Americans.”

“But this is one,” Ms. Kelly responded.

Dr. Frieden implied a travel ban would be harmful: “If we do things that are going to make it harder to stop the epidemic there, it’s going to spread to other parts of—”

Ms. Kelly interjected, asking how keeping citizens from the affected regions out of America would make it harder to stop Ebola in Africa.

Dr. Frieden replied that limiting travel between African nations would slow relief efforts. “If we isolate these countries, what’s not going to happen is disease staying there. It’s going to spread more all over Africa and we’ll be at higher risk.”

Later in the interview, Ms. Kelly noted that we still have airplanes coming into the U.S. from Liberia, with passengers expected to self-report Ebola exposure.

Dr. Frieden responded: “Ultimately the only way—and you may not like this—but the only way we will get our risk to zero here is to stop the outbreak in Africa.”

Ms. Kelly said yes, that’s why we’re sending troops. But why can’t we do that and have a travel ban?

“If it spreads more in Africa, it’s going to be more of a risk to us here. Our only goal is protecting Americans—that’s our mission. We do that by protecting people here and by stopping threats abroad. That protects Americans.”

Dr. Frieden’s logic was a bit of a heart-stopper. In fact his responses were more non sequiturs than answers. We cannot ban people at high risk of Ebola from entering the U.S. because people in West Africa have Ebola, and we don’t want it to spread. Huh?

In testimony before Congress Thursday, Dr. Frieden was not much more straightforward. His answers often sound like filibusters: long, rolling paragraphs of benign assertion, advertising slogans—“We know how to stop Ebola,” “Our focus is protecting people”—occasionally extraneous data, and testimony to the excellence of our health-care professionals.

It is my impression that everyone who speaks for the government on this issue has been instructed to imagine his audience as anxious children. It feels like how the pediatrician talks to the child, not the parents. It’s as if they’ve been told: “Talk, talk, talk, but don’t say anything. Clarity is the enemy.”

The language of government now is word-spew.

Dr. Frieden did not explain his or the government’s thinking on the reasons for opposition to a travel ban. On the other hand, he noted that the government will consider all options in stopping the virus from spreading here, so perhaps that marks the beginning of a possible concession.

It is one thing that Dr. Frieden, and those who are presumably making the big decisions, have been so far incapable of making a believable and compelling case for not instituting a ban. A separate issue is how poor a decision it is. To call it childish would be unfair to children. In fact, if you had a group of 11-year-olds, they would surely have a superior answer to the question: “Sick people are coming through the door of the house, and we are not sure how to make them well. Meanwhile they are starting to make us sick, too. What is the first thing to do?”

The children would reply: “Close the door.” One would add: “Just for a while, while you figure out how to treat everyone getting sick.” Another might say: “And keep going outside the door in protective clothing with medical help.” Eleven-year-olds would get this one right without a lot of struggle.

If we don’t momentarily close the door to citizens of the affected nations, it is certain that more cases will come into the U.S. It is hard to see how that helps anyone. Closing the door would be no guarantee of safety—nothing is guaranteed, and the world is porous. But it would reduce risk and likelihood, which itself is worthwhile.

Africa, by the way, seems to understand this. The Associated Press on Thursday reported the continent’s health-care officials had limited the threat to only five countries with the help of border controls, travel restrictions, and aggressive and sophisticated tracking.

All of which returns me to my thoughts the past few weeks. Back then I’d hear the official wordage that doesn’t amount to a logical thought, and the unspoken air of “We don’t want to panic you savages,” and I’d look at various public officials and muse: “Who do you think you are?”

Now I think, “Who do they think we are?”

Does the government think if America is made to feel safer, she will forget the needs of the Ebola nations? But Americans, more than anyone else, are the volunteers, altruists and in a few cases saints who go to the Ebola nations to help. And they were doing it long before the Western media was talking about the disease, and long before America was experiencing it.

At the Ebola hearings Thursday, Rep. Henry Waxman (D., Calif.) said, I guess to the American people: “Don’t panic.” No one’s panicking—except perhaps the administration, which might explain its decisions.

Is it always the most frightened people who run around telling others to calm down?

This week the president canceled a fundraiser and returned to the White House to deal with the crisis. He made a statement and came across as about three days behind the story—“rapid response teams” and so forth. It reminded some people of the statement in July, during another crisis, of the president’s communications director, who said that when a president rushes back to Washington, it “can have the unintended consequence of unduly alarming the American people.” Yes, we’re such sissies. Actually, when Mr. Obama eschews a fundraiser to go to his office to deal with a public problem we are not scared, only surprised.

But again, who do they think we are? You gather they see us as poor, panic-stricken people who want a travel ban because we’re beside ourselves with fear and loathing. Instead of practical, realistic people who are way ahead of our government.

Career

Capitol Hill career

Klain’s early experience on Capitol Hill included serving as Legislative Director for U.S. RepresentativeEd Markey. From 1989 to 1992, he served as Chief Counsel to the U.S. Senate Committee on the Judiciary, overseeing the legal staff’s work on matters of constitutional law, criminal law, antitrust law, and Supreme Court nominations. In 1995, Senator Tom Daschle appointed him the Staff Director of the Senate Democratic Leadership Committee.

Clinton administration

Klain joined the Clinton-Gore campaign in 1992. He ultimately was involved in both of Bill Clinton‘s campaigns, oversaw Clinton’s judicial nominations, and was General Counsel to Al Gore’s recount committee in the 2000 election aftermath. Some published reports have given him credit for Clinton’s “100,000 cops” proposal during the 1992 campaign; at a minimum, he worked closely with Clinton aide Bruce Reed in formulating it. In the White House, he was Associate Counsel to the President, directing judicial selection efforts, and led the team that won confirmation of Supreme Court Associate Justice Ruth Bader Ginsburg. Klain left the judicial selection role in 1994 to become Chief of Staff and Counselor to Attorney General Janet Reno. In 1995, he became Assistant to the President, and Chief of Staff and Counselor to Al Gore.

Gore campaign

During Klain’s tenure as Gore’s Chief of Staff, Gore consolidated his position as the likely Democratic nominee in 2000. Still, Klain was seen as too loyal to Clinton by some longtime Gore advisors. Feuding broke out between Clinton and Gore loyalists in the White House in 1999, and Klain was ousted by Gore campaign chairmanTony Coelho in August of that year. In October 1999, he joined the Washington, D.C. office of the law firm of O’Melveny & Myers. A year later, Klain returned to the Gore campaign, once Coelho was replaced by William M. Daley. Daley hired Klain for a senior position in the Gore campaign and then named him General Counsel of Gore’s Recount Committee.

Legal career

In 1994, Time named Klain one of the “50 most promising leaders in America” under the age of 40. In 1999, Washingtonian magazine named him the top lawyer in Washington under the age of 40, and the American Bar Association’s Barrister magazine named him one of the top 20 young lawyers nationwide. The National Law Journal named him one of its Lawyers of the Year for 2000.

Lobbying

Klain helped Fannie Mae overcome “regulatory issues”.[8]Lobbying on “regulatory issues concerning Fannie Mae” in 2004, as disclosure forms indicate Klain did, involved convincing Congress and Fannie Mae’s regulators that Fannie Mae wasn’t doing anything dangerous, and wasn’t exposing taxpayers to risk. In other words, Ron Klain got paid to help fuel the housing bubble up until a couple of years before it popped.

2004-2008

During the 2004 Presidential campaign, Klain worked as an adviser to Wesley Clark in the early primaries. Later, during the General Election, Klain was heavily involved behind the scenes in John Kerry‘s campaign and is widely credited for his role in preparing Senator Kerry for a strong performance in the debates against President George W. Bush, which gave Kerry a significant boost in the polls.[9] He then acted as an informal adviser to Evan Bayh, who is from Klain’s home state of Indiana. Klain has also commented on matters of law and policy on televised programs such as the Today Show, Good Morning America, Nightline, Capital Report,NewsHour with Jim Lehrer, and Crossfire.

In 2005, Klain left his partnership at O’Melveny & Myers to serve as Executive Vice President and General Counsel of a new investment firm, Revolution LLC, launched by AOL co-founder Steve Case.[citation needed]

Klain was mentioned as a possible replacement for White House Chief of Staff Rahm Emanuel,[12] but opted to leave the White House for a position in the private sector in January 2011.[2]

Klain apparently signed off on President Obama’s support of a $535 million loan guarantee for now-defunct solar-panel company Solyndra. Despite concerns about whether the company was viable, Klain approved an Obama visit, stating, “The reality is that if POTUS visited 10 such places over the next 10 months, probably a few will be belly-up by election day 2012.”[13]

Dr. Lurie is the Assistant Secretary for Preparedness and Response (ASPR) at the US Department of Health and Human Services (HHS).

The mission of her office is to lead the nation in preventing, responding to and recovering from the adverse health effects of public health emergencies and disasters, ranging from hurricanes to bioterrorism.
Dr. Lurie was previously Senior Natural Scientist and the Paul O’ Neill Alcoa Professor of Health Policy at the RAND Corporation. There she directed RAND’s public health and preparedness work as well as RAND’s Center for Population Health and Health Disparities. She also served as Principal Deputy Assistant Secretary of Health in the US Department of Health and Human Services; in state government, as Medical Advisor to the Commissioner at the Minnesota Department of Health; and in academia, as Professor in the University of Minnesota Schools of Medicine and Public Health. Dr. Lurie has a long history in the health services research field, primarily in the areas of access to and quality of care, mental health, prevention, public health infrastructure and preparedness and health disparities.

Dr. Lurie attended college and medical school at the University of Pennsylvania, and completed her residency and MSPH at UCLA, where she was also a Robert Wood Johnson Foundation Clinical Scholar. She is the recipient of numerous awards, and is a member of the Institute of Medicine.

Finally, Dr. Lurie continues to practice clinical medicine in the health care safety net in Washington, DC. She has three sons.

The Assistant Secretary for Preparedness and Response serves as the Secretary’s principal advisor on matters related to bioterrorism and other public health emergencies. The ASPR also coordinates interagency activities between HHS, other Federal departments, agencies, and offices, and State and local officials responsible for emergency preparedness and the protection of the civilian population from acts of bioterrorism and other public health emergencies.[2] The mission of her office is to lead the nation in preventing, responding to and recovering from the adverse health effects of public health emergencies and disasters. Dr. Lurie was nominated to the position by President Obama on May 12, 2009[3] and her confirmation by the U.S. Senate[4] was announced by HHS Secretary Kathleen Sebelius on July 10, 2009.[5]

Early career

Dr. Lurie has served as the Senior Natural Scientist and the Paul O’ Neill Alcoa Professor of Health Policy at the RAND Corporation.[7] There she directed RAND’s public health and preparedness work as well as RAND’s Center for Population Health and Health Disparities. She has previously served in federal government, as Principal Deputy Assistant Secretary of Health in the US Department of Health and Human Services; in state government, as Medical Advisor to the Commissioner at the Minnesota Department of Health; and in academia, as Professor in the University of Minnesota School of Medicine and the University of Minnesota School of Public Health. Dr. Lurie has a long history in the health services research field, primarily in the areas of access to and quality of care, managed care, mental health, prevention, public health infrastructure and preparedness and health disparities.

Lurie has served as the Senior Editor for Health Services Research and has served on editorial boards and as a reviewer for numerous journals. She has served on the council and was President of the Society of General Internal Medicine,[8] and on the board of directors for Academy Health, and has served on multiple other national committees.